Individual
DR. RHETT BAYLOR JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
4829 E BELTLINE AVE NE, GRAND RAPIDS, MI 49525-9747
(616) 550-0087
Mailing address
4829 E BELTLINE AVE NE, GRAND RAPIDS, MI 49525-9747
(616) 550-0087
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901600527APP20
MI
Other
Enumeration date
04/29/2020
Last updated
04/29/2020
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